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Impact of patients’ refusal to undergo adjuvant treatment measures on survival

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients’ refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany.

Methods

A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan–Meier survival analyses, and Cox regression analyses regarding the effects of their refusal.

Results

About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ2 = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ2radiotherapy = 109.1; df = 1; p < 0.001, χ2chemotherapy = 18.3; df = 1; p < 0.001, χ2endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ2radiotherapy = 184.9; df = 6; p < 0.001; χ2chemotherapy = 191.8; df = 6; p < 0.001).

Conclusions

All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients’ refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.

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Acknowledgements

We thank all the people who contributed to the establishment and maintenance of our databank on breast cancer. This includes our tumour documenters—namely, Mrs Andrea Heuberger—as well as all gynaecologists and general practitioners in our region who informed us about the follow-up of the patients. We would especially like to thank Mr Alexander Schattenberg, who developed the MaDos documentation system and was always ready to assist us with special queries.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to H. Männle.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A positive ethics vote from the University of Freiburg i.Br, Germany, was given (No. 161/20).

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Informed consent was obtained from all individual participants included in the study.

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Männle, H., Siebers, J.W., Momm, F. et al. Impact of patients’ refusal to undergo adjuvant treatment measures on survival. Breast Cancer Res Treat 185, 239–246 (2021). https://doi.org/10.1007/s10549-020-05939-1

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  • DOI: https://doi.org/10.1007/s10549-020-05939-1

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